Campos-Rodriguez Francisco, Peña-Griñan Nicolas, Reyes-Nuñez Nuria, De la Cruz-Moron Ines, Perez-Ronchel Jose, De la Vega-Gallardo Francisco, Fernandez-Palacin Ana
Department of Respiratory Medicine, Valme University Hospital, Sevilla, España.
Chest. 2005 Aug;128(2):624-33. doi: 10.1378/chest.128.2.624.
The aims of this study were to analyze mortality in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) treated with positive airway pressure (PAP) and to know whether PAP compliance affects survival, as well as to investigate the prognostic value of several pretreatment variables.
A study was made of an historical cohort of 871 patients in whom OSAHS had been diagnosed by sleep study between January 1994 and December 2000 and who had been treated with PAP. Patients were followed up until December 2001. The mean (+/- SD) age of the group was 55.4 +/- 10.6 years, the mean apnea-hypopnea index (AHI) 55.1 +/- 28.7, and 80.9% were men. To assess whether mortality was influenced by PAP therapy compliance, patients were assigned to one of the following compliance categories: < 1 h/d; 1 to 6 h/d; or > 6 h/d. Survival rates were calculated according to the Kaplan-Meier method. Survival curves were compared with the log-rank test and the trend test, when necessary. Univariate and multivariate analyses using a time-dependent Cox model were performed to elicit which variables correlated with mortality.
Outpatient sleep disorders unit.
By the end of the follow-up period (mean duration, 48.5 +/- 22.7 months), 46 patients had died. The 5-year cumulative survival rates were significantly lower in patients who did not use PAP (compliance < 1 h) than in those who used the device for > 6 h/d (85.5% [95% confidence interval (CI), 0.78 to 0.92] vs 96.4% [95% CI, 0.94 to 0.98; p < 0.00005]) and 1 to 6 h/d (85.5% [95% CI, 0.78 to 0.92] vs 91.3% [ 95% CI, 0.88 to 0.94; p = 0.01]), respectively. A trend in survival rates across the groups was identified (p = 0.0004). The main cause of death in 19 cases was cardiovascular disease (CVD). Variables that independently correlated with mortality in the multivariate analysis were the following PAP use categories: compliance for > 6 h/d (odds ratio [OR], 0.10; 95% CI, 0.04 to 0.29); compliance for 1 to 6 h/d (OR, 0.28; 95% CI, 0.11 to 0.69); arterial hypertension (AHT) [OR, 3.25; 95% CI, 1.24 to 8.54]; age (OR, 1.06; 95% CI, 1.01 to 1.10); and FEV1 percent predicted (OR, 0.96; 95% CI, 0.94 to 0.98).
Mortality rates in OSAHS patients who did not receive PAP therapy were higher compared with those treated with PAP and were moderately or highly compliant with therapy. A trend in survival across compliance categories was found. Patients died mainly from CVD. Categories of PAP compliance, AHT, age, and FEV1 percent predicted were the variables that independently predicted mortality.
本研究旨在分析接受气道正压通气（PAP）治疗的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的死亡率，了解PAP治疗依从性是否影响生存率，并探讨几个治疗前变量的预后价值。
对1994年1月至2000年12月期间经睡眠研究确诊为OSAHS并接受PAP治疗的871例患者的历史队列进行研究。对患者随访至2001年12月。该组患者的平均（±标准差）年龄为55.4±10.6岁，平均呼吸暂停低通气指数（AHI）为55.1±28.7，男性占80.9%。为评估PAP治疗依从性是否影响死亡率，将患者分为以下依从性类别之一：<1小时/天；1至6小时/天；或>6小时/天。根据Kaplan-Meier方法计算生存率。必要时，采用对数秩检验和趋势检验比较生存曲线。使用时间依赖性Cox模型进行单因素和多因素分析，以确定哪些变量与死亡率相关。
门诊睡眠障碍科。
到随访期末（平均随访时间为48.5±22.7个月），46例患者死亡。未使用PAP（依从性<1小时）的患者5年累积生存率显著低于每天使用该设备>6小时的患者（85.5%[95%置信区间（CI），0.78至0.92]对96.4%[95%CI，0.94至0.98；p<0.00005]）和1至6小时/天的患者（85.5%[95%CI，0.78至0.92]对91.3%[95%CI，0.88至0.94；p = 0.01]）。各亚组间生存率存在趋势性差异（p = 0.0004）。19例患者的主要死亡原因是心血管疾病（CVD）。多因素分析中与死亡率独立相关的变量包括以下PAP使用类别：依从性>6小时/天（比值比[OR]，0.10；95%CI，0.04至0.29）；依从性1至6小时/天（OR，0.28；95%CI，0.11至0.69）；动脉高血压（AHT）[OR，3.25；95%CI，1.24至8.54]；年龄（OR，1.06；95%CI，1.01至1.10）；以及预测的第一秒用力呼气容积（FEV1）百分比（OR，0.96；95%CI，0.94至0.98）。
未接受PAP治疗的OSAHS患者的死亡率高于接受PAP治疗且治疗依从性为中度或高度的患者。发现各依从性类别间存在生存趋势。患者主要死于CVD。PAP治疗依从性类别、AHT、年龄和预测的FEV1百分比是独立预测死亡率的变量。
